Depression is broadly classified into nine different types and treatment regimen depends on the evaluation and actual type of depression. In the US, an estimated 17 million adults are reportedly diagnosed with one of any of the above mental disorders, accounting for 7% of the population.  Treatment typically includes combinations of medications that are prescribed in varying strengths as per the unique requirement of each case. One of the most common forms of mental disorder is major depression. Medications prescribed for the condition include tetracycline antidepressants, such as Mirtazapine that has other off label benefits including weight gain and treatment of sleep related disorders. The following subsections will offer a detailed coverage of Remeron, one of the branded forms of Mirtazapine. This will help learn all about the possible side effects of Remeron and help patients prevent or mitigate the undesirable effects.

Overview of Remeron

The medication is used for treating neurological disorders, and its mechanism of action helps individuals gain weight that has been lost due to one of many reasons. It is also used in post-surgical care to help prevent nausea and vomiting in patients. Insomnia, as mentioned above is another condition that is also managed with a certain degree of effectiveness with the medication. The formulation begins to deliver results in one week from the time of commencing treatment. The highlight of the medication is the relatively lesser side effects associated with it, unlike other medications for depression.

Mechanism of action of Remeron

The mechanism of action of Remeron is attributed to the activity in the central nervous system, viz., the serotonergic and central adrenergic activity. This is essentially the primary action of the medication and delivers the antidepressant effects. Other properties of the medication, include its role as a histamine receptor agonist and actions on the pain receptors. These properties deliver sedative effects, making it useful in helping treat patients with insomnia, apart from pain management.

Important information about the side effects of the drug

The drug comes with a very high level of warning, and it is necessary for caregivers and healthcare professionals to be alert to the possible undesirable outcomes associated with the drug. Remeron figures on the list of drugs that come with a black box warning issued by the FDA, cautioning users about effects that may be experienced either with long term/short term use. Effects that may be witnessed include

This is more likely to be witnessed during the period after commencing the medication. Caregivers are to constantly monitor for any change in behavior or actions that indicate any intent to commit suicide.

Other serious side effects of Remeron

In addition to the above warnings, there is also the likelihood of Remeron having withdrawal symptoms, and this is common to all antidepressants, especially patients with extended periods of treatment for depression. Due to the mechanism of action of the medication and the properties, it is specifically advised that the dosage is not to be stopped abruptly as it could result in withdrawal symptoms. The best way to end the treatment is to gradually reduce dosage, with specialist advice, and finally stop the treatment, whenever necessary.

Various indications point to withdrawal effects, and this includes abnormal sweating, and confused feelings in the patient. There is also the possibility of patients experiencing a cold, apart from a surge in dreaming episodes. Feelings of anxiety, and agitation are other possible outcomes of effects. This will always not have any link to any reason and devoid of logic. The patient is also likely to experience some kind of shock sensations and stimuli, that may trigger involuntary actions, and this may appear as erratic or inconsistent behavior. In addition to the above, the patient is also likely to experience withdrawal symptoms such as feelings of dizziness and fatigue for no attributable reason.

Effect of Remeron on routines

The patient is also likely to experience impact on routines. For instance, the medication has potent sedative effect and this will have an impact on the reflexes of the patient and the ability of the patient to respond with the required degree of alertness in professional responsibilities. Consequently, the patient may not be in a position to fully discharge certain responsibilities, especially if the tasks involve operating heavy machinery, driving, or working in an environment that is hazardous.

Visible effects or manifestations resulting from long term use of Remeron

As a result of long-term use of the medication, there is the possibility of patients gaining weight, especially those who have lost weight in the past due to certain reasons. Consequently, there could be visible changes in patients, in addition to changed routines or behavior. For instance, the patient may be prone to binge eating as a result of increased craving for food. It may be necessary for patients to take up some form of exercise routine to handle the effects of increased dietary intake. One of the problems that is likely to be faced by patients on the medication is the possible inability or lack of desire/intent among patients with depression to take up exercising. The impact on the central nervous system that results in increased eating may be difficult to fix, due to the nature of the condition.

During certain stages of depression, it is wrong to expect the patient to take up exercising. However, after depression has been controlled to a certain extent, it may be possible for individuals to try out exercises. Patients diagnosed with depression, who are already obese may be required to pick other suitable medications in place of Remeron. There are clear reasons behind this advice, obese patients who continue to rapidly increase weight may actually end up with more serious complications, that may require additional or special treatment.

Serotonin syndrome and the need to stay alert to prevent the condition

Medications that are likely to increase serotonin levels beyond a particular level are all known to come with increased risk of serious effects. For instance, side effects of Remeron include serotonin syndrome, that presents in most antidepressant medications. The increase in serotonin levels may actually be experienced differently by patients, depending on various factors. For instance, pronounced effects may be experienced by certain patients, while for most patients the effects may not be severe. In rare instances, there is also the possibility of fatal outcomes from serotonin syndrome. The patient may go into a coma, or could experience seizures, or possible kidney failure due to rare effects of increase in serotonin.

The neurotransmitter is linked to mood, and feelings of happiness. When medication or substances that boost or increase the level of serotonin are consumed alongside other medications that also increase serotonin levels, there is the danger of an increase in the neurotransmitter levels.

The sudden or abnormal increase may result in possible agitation, and a confused state of mind of the patient. This could trigger outcomes such as hallucination and could also affect the ability of the patient to think logically.  The patient is likely to find it difficult to have coordinated movements, in addition to experiencing uncontrollable muscle twitching that is not attributed to any specific reason. Blood pressure levels likely to fluctuate, with a possible increase or decrease in blood pressure. This may or may not be accompanied by a change in heartbeat rate. Other possible outcomes of this increase could include nausea and fever.

The neurotransmitter, responsible for various actions, works by facilitating communication between the brain cells and nervous system cells. This in turn has an impact on sleeping, eating and functions such as digestion. However, when the levels spike beyond a certain level, there is the possibility of the patient experiencing any of the above effects.

Dosage information 

Remeron is available in strengths of 15 mg, 30 mg and 45 mg in immediate release and dissolving formulations. The ideal dosage for depression patients is 15mg daily for patients between 18 and 64 years.  While there is the possibility of the dosage being reduced as per the evaluation of the patient and other determining factors, there is an upper limit to the dosage. In other words, the upper limits should not be in excess of 45 mg daily, regardless of the condition.  The dosage is also to be increased in stages, and not abruptly, by continuing with one dosage for a particular period, before gradually increasing it to the next level.

Elderly patients are to be administered dosages of lesser strengths, and this is to be carried out as per assessments. This is mainly because of the inability of the kidneys to process the drug, and as a consequence, the drug may remain in the body for a longer time. This may expose the patient to increased risks of ailments. The effectiveness and the possible effects of the medication has not been studied in youngsters and this makes it necessary for a specific or special evaluation of individuals aged below 18 years, before being prescribed the drug.

Drug interactions

There is the possibility of drug interactions, between Remeron and medications, or OTC medications, and herbal or natural supplements. Whenever the medication is taken alongside MAOIs, there is the possibility of an increase in serotonin levels, and possible serotonin syndrome. Remeron may also interact with methylene blue, lithium, triptans and linezolid, and this interaction could trigger an increase in serotonin levels, with possible risk of undesirable effects. The best method to mitigate the issue, is to ensure that there is a clear gap of two weeks between two medications. In other words, any medication that is known to interact is to be taken only two weeks after the other medication has been consumed.

Other drug interactions and possible side effects of Remeron may be experienced when the medication is taken alongside benzodiazepines, antipsychotics, antibiotics, and blood thinners. The possible outcomes of these interactions could include changed heart beat rhythm, in addition to exposing the patient to possible increase in bleeding. Allergies are another possible outcome, and is mainly witnessed as swelling either on the face, the tongue, the eyes, or as skin rashes.




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